LGBTQIA+ Discrimination and Eugenics in the American Society for Reproductive Medicine (ASRM) Guidelines for Gamete and Embryo Donation: Series 2: Nod towards Cisgender, Heterosexual couples

By Devin Shuman, MS, CGC and Jenny Rietzler, MS, CGC

Hopefully after reading part one of our new series, LQBTQIA+ Discrimination and Eugenics in the American Society for Reproductive Medicine (ASRM) Guidelines for Gamete and Embryo Donation, you’ve reviewed the ASRM recommendations and realized that their failure at inclusivity extends far beyond their discriminatory practices towards gay sperm donors. In part two, we focus on how ASRM imposes their own value system of “prenatal optimization” onto patients regarding who is “qualified” to contribute to this future family, centering cisgender, heterosexual, sexually intimate partners as the default unit. 

The guidelines start with noble intentions: “The availability of donor gametes [egg/sperm] provides individuals and couples who otherwise may not be able to conceive with an opportunity to build a family.” And it appears that ASRM is trying to sound inclusive towards all family structures. If you’re a single parent wanting to use a donor – awesome! If you are a same sex couple wanting to use a donor – good for you! But what about reciprocal donation? In other words, female partners where one carries the pregnancy, while the egg of their partner was “donated” or used for the conception. Per the guidelines, “Donors are defined as individuals who are not sexually intimate partners of the recipients.” That sentence appears inclusive of reciprocal donation, assuming the female partners participating in reciprocal donation are sexually intimate. However, a stipulation emerges. Later on there is clarification as to why lesbian couples are included in the donor guidelines: “In this setting, the partner does not donate her oocytes [eggs]. The oocytes should be considered shared between sexually intimate partners because sperm is shared between heterosexual couples, presumed to be sexually intimate.” . . . Come again? So because heterosexual couples can do it, I suppose we will let it count for lesbians too? They had the opportunity to frame it around being in a committed relationship, but focused on sperm instead. *Insert face palm emoji*

Further, when discussing embryo donation and exceptions to sperm/egg donor requirements, ASRM consistently frames the default/norm to be “sexually intimate couples”, as already mentioned above. So if you’re an asexual couple or want to create a family with a platonic partner – you don’t have a place in these guidelines? On this same thread, ASRM has a second relevant position statement on access to fertility treatment “irrespective of material status” which starts on shaky ground with the statement that “most diverse sexuality and gender (DSG) individuals and couples cannot biologically reproduce on their own.” This is a pretty big leap to assume the vast majority of couples with gender-queer, non-binary, or trans individuals will require assistance with reproduction. This just furthers the narrative of othering the LGBTQ+ community as “deviations from the norm”.

While this position statement at least states the obvious that “infertility clinics should treat persons equally, regardless of sexual orientation or gender identity, the fact that ASRM even frames this as an “ethical debate” is absurd; framing  “welfare concerns” and “religious beliefs” as excuses for discrimination should never be validated. In our research, we’ve also learned fertility insurance guidelines have not caught up. Many insurance policies require a medical diagnosis of infertility that is defined in heterosexual terms, or proof that the individual/couple is unable to conceive children through intercourse. Forcing a couple to have unprotected sex for 6-12 months to “prove infertility” when they don’t even have the organs necessary to create a pregnancy together is an unnecessary barrier to the point of being discriminatory. Cathy Sakimura, director of family law at the National Center for Lesbian Rights, was quoted in a Washington Post article from April of 2022: “LGBTQ people are not being thought of, and you could say were actively excluded, in the creation of fertility insurance generally and the statutes that address fertility insurance.”

OK, back to the original ASRM guidelines. When discussing donor psychoeducational counseling the recommendations state that “partners should be included in the clinical interview”. This once again assumes being in a relationship is the default. It also flashes us back to the 1950s housewife needing their husband’s permission for a medical procedure or a bank account. This theme also came up in their other position statement under a blurb titled, “Interests of Nondisclosed Spouses”, where providers may refuse to provide fertility treatment unless they have adequate assurance that a spouse has been informed of the treatment and does not object to it. Not to mention their statement that clinics can deny services to individuals or couples based on “serious and substantiated doubts about whether they will be fit or responsible child-rearers”, which leaves the door wide open for personal biases and discriminatory assessments by providers to stack the odds against LGBTQIA+ patients. 

ASRM states that their goal is to provide the opportunity for the creation of families, but the underpinning of the language used squeezes people interested in reproducing with assisted reproductive technologies (ART) into a narrowly defined box and adds additional barriers for those that might need to rely on ART to build a family. We can and we should be doing better. Healthcare providers should not have the right to decide who is allowed to create a family or have children.

Genetic Support Foundation stands with other medical providers and organizations in the fight for inclusive healthcare. If you’d like to talk with a genetic counselor about your family planning goals and options for preconception screening, contact us today to meet with one of our reproductive genetic counselors via telehealth.